Provider Demographics
NPI:1619650579
Name:DAVIS, MAKAYLA (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PETER PARLEY RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2914
Mailing Address - Country:US
Mailing Address - Phone:860-301-4630
Mailing Address - Fax:
Practice Address - Street 1:44 PETER PARLEY RD
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2914
Practice Address - Country:US
Practice Address - Phone:860-301-4630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3198055171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach